Improving Blood Sugar Estimates

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Diabetes occurs when your blood glucose, or blood sugar, is too high. Over time, having too much glucose in your blood can cause health problems, such as heart disease, nerve damage, eye disorders, and kidney disease. The primary test used to estimate glucose levels for diabetes management is called the A1C test. The A1C test measures the amount of glucose attached to hemoglobin, the protein in red blood cells that carries oxygen. Red blood cells are constantly forming and dying. They typically live for about 3 months. Therefore, A1C results provide an estimate of a person’s average blood glucose levels over the past 3 months. However, levels of hemoglobin with glucose attached (glycated hemoglobin) can fluctuate depending on factors other than blood glucose, making A1C testing somewhat inaccurate.

To improve the accuracy of blood sugar estimates, a team led by Dr. John Higgins at Harvard Medical School and Massachusetts General Hospital investigated individual biological differences that may affect A1C results. The research was funded in part by National Institutes of Health’s (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and an NIH Director’s New Innovator Award. Results were published in Science Translation Medicine on October 5, 2016.

The researchers analyzed data from their own hospital as well as from 3 previously published studies to assess how well the amount of glucose attached to hemoglobin reflects patients’ actual blood glucose levels. They found that the correlation was somewhat different for each patient. Using mathematical modeling, the team investigated biological differences that might contribute to the data’s variation.

Red blood cell turnover can occur on slightly different timescales for each person. Older red blood cells have more time to accumulate glycated hemoglobin than newer red blood cells. Differences in the average age of red blood cells for each patient, the researchers found, accounted for all of the variation seen between levels of glycated hemoglobin and blood glucose.

To personalize the model’s estimates, the team acquired data for more than 200 patients from 4 independent studies. The researchers determined the average red blood cell age for each person based on the relationship between continuous glucose measurements—taken using a tiny sensor inserted under the skin—and glycated hemoglobin measurements taken from a blood test. Using this information in the model, each patient’s average blood glucose levels could be calculated based on A1C tests with higher accuracy than the current standard method, reducing estimation errors by more than 50%.

“What we currently deem the gold standard for estimating average blood glucose is nowhere as precise as it should be,” says Higgins. “Our study not only pinpoints the root of the inaccuracy but also offers a way to get around it.” More research is needed to determine how long continuous glucose measurements need to be taken to give the most precise results using this model.

Adapted from: Tianna Hicklin, Ph.D.

Reference: Mechanistic modeling of hemoglobin glycation and red blood cell kinetics enables personalized diabetes monitoring. Malka R, Nathan DM, Higgins JM. Sci Transl Med. 2016 Oct 5;8(359):359ra130. PMID: 27708063.

Nutrition Tip of the Day

Learn How To Read The Labels! When you know how to read nutrition labels, shopping for healthier food gets a little easier. The Nutrition Facts table provides information on the calories and nutrients in a specific serving size of food. You can check the serving size and compare it to how much food you actually eat. The % Daily Value (% DV) on the Nutrition Facts table shows you if a food has “a little” or “a lot” of a nutrient. For example, 5% DV or less is a little of a nutrient, and 15% DV or more is a lot of a nutrient.

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5 Whole Grains to Keep Your Family Healthy

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Next time you go shopping, help keep your family healthy by choosing whole grains over refined grains. Whole grains (such as buckwheat, brown rice, hominy and oatmeal) are more nutritious than refined grains because they contain the fiber-rich outer bran layer, the nutrient-packed germ and the starchy endosperm. Refined grains (such as white bread, white pasta and white rice) contain mostly the endosperm. In the past, whole grains were thought to provide mostly fiber to promote digestive and heart health, but newer research has revealed that they provide additional vitamins and minerals, plus high levels of antioxidants and other healthy plant-based nutrients. No matter which whole grain you prefer, make sure the ingredient list includes whole grains or that the label reads “100-percent whole grain.”

Amaranth

Gluten-free amaranth is considered a complete protein because it contains all of the essential amino acids in proportions that humans need, including lysine which other grains tend to lack. Additionally, it’s a good source of minerals such as iron, magnesium and zinc, plus it offers some calcium and potassium. In South America, amaranth is popped like miniature popcorn. “Most kids love pasta, and amaranth can be used as a substitute for couscous or orzo,” said Nancy Z. Farrell, MS, RDN, who is a spokesperson for the Academy of Nutrition and Dietetics. “Use amaranth flour to make tasty baked products like zucchini bread, carrot cake or blueberry muffins and pancakes.”

Barley

Barley is a fiber powerhouse. Hulled barley has more fiber-rich bran than pearled barley, “but both contain beta-glucan soluble fiber that slows the absorption of glucose, and helps to keep blood sugar levels stable, thus providing sustained energy throughout the day,” says Farrell. Barley also contains selenium, a powerful antioxidant. Barley is great added to soups or used to make a pilaf. It can even be made into a hot breakfast cereal. Hulled barley will take more time to cook than pearled barley, about 50 to 60 minutes.

Oats

Oats also contain beta-glucan fiber which can lower cholesterol and help strengthen the immune system. Oats boast polyphenol compounds that have antioxidant and anti-itch properties. Besides the age-old favorite oatmeal for breakfast, oats can be added as a binder to meatloaf and burgers. Oats also work well in baked goods including oatmeal cookies, as a crunchy topping to crisps and crumbles, and even in casserole dishes.

Quinoa

Like amaranth, quinoa contains all nine essential amino acids and is gluten-free. Moreover, quinoa is an excellent source of magnesium and a good source of zinc, iron and folate. “Quinoa is easy to make,” said Farrell. “While not required, toasting quinoa before boiling it in liquid enhances flavor, as does cooking it in vegetable or chicken broth.” Quinoa can be made in a rice cooker, as well. Before cooking, use a fine mesh strainer to rinse the quinoa and remove the outer coating, called saponin, which can give the quinoa a bitter taste. Quinoa is fun for kids because it pops in the mouth when chewed and comes in several colors: beige, red, black and even purple. Mix quinoa with beans or nuts for a tasty side dish, or add to salads and stir-fries.

Teff

Of these five grains, gluten-free teff is highest in calcium and protein. Teff also is a rich source of fiber, iron and thiamin. Teff grains are tiny and have a mild nutty flavor. It’s an indispensable grain in Ethiopia where it’s used to make the traditional flat bread, injera, and it’s grown in the United States in Idaho. Cook the grain into a creamy hot cereal or a tasty polenta. You can also mix teff with veggies for a side dish.

Adapted from: Andrea Giancoli, MPH, RD

Nutrition Tip of the Day

Keep tomatoes on the counter, out of direct sunlight, so they stay fresh and flavourful.

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Preschoolers benefit from peanut allergy therapy

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Peanuts are one of the most common causes of food allergies. Allergic reactions to peanuts can be mild, but they may also be severe and lead to a life-threatening allergic reaction called anaphylaxis. Peanut allergy usually starts in early childhood and lasts a lifetime. Avoiding exposure is the best way to prevent an allergic reaction. However, steering clear of peanuts is difficult, since it can be in foods you may not suspect.

Recent studies have shown that an experimental treatment called oral immunotherapy can reduce allergies to some foods, including peanuts. A team of researchers led by Dr. Wesley Burks at the University of North Carolina at Chapel Hill tested the approach as an early intervention in preschool-age children newly diagnosed with peanut allergy. The work was partly supported by the National Institute of Health’s (NIH) National Institute of Allergy and Infectious Diseases (NIAID) and National Center for Advancing Translational Sciences (NCATS). Results were published online in the Journal of Allergy and Clinical Immunology on August 10, 2016.

The team enrolled 40 young children (9 to 36 months old) newly diagnosed with peanut allergy. The treatment involved eating small, gradually increasing amounts of peanut protein each day. Participants were randomly assigned to either a high-dose (target daily dose of 3,000 milligrams peanut protein) or a low-dose regimen (target dose of 300 milligrams). Data from a group of 154 peanut-allergic children who had received standard care and avoided peanuts were used as a control.

Nearly all treated participants experienced some side effects, such as abdominal pain. These were generally mild and required little or no treatment. Three people withdrew from the study because of adverse effects. Two others withdrew for other reasons.

After receiving treatment for 29 months on average, participants ate a peanut-free diet for 4 weeks and then were evaluated for their ability to eat 5 grams of peanut protein. Almost 80% of treated participants had no allergic response. There was no significant difference between the low-dose and high-dose arms. In comparison, only 4% of the control group successfully introduced peanuts into their diet. These results are substantially better than those in older children who had a longer duration of peanut allergy.

“This study provides critical evidence supporting the safety and effectiveness of peanut oral immunotherapy in treating young children newly diagnosed with peanut allergy,” says NIAID food allergy expert Dr. Marshall Plaut. Researchers continue to monitor the participants to assess how long the treatment effects may last. Scientists note that this experimental therapy is still being tested in clinical trials and should be given only under medical supervision. Consult with a doctor before giving peanut products to an allergy-prone child.

Vickery BP, Berglund JP, Burk CM, Fine JP, Kim EH, Kim JI, Keet CA, Kulis M, Orgel KG, Guo R, Steele PH, Virkud YV, Ye P, Wright BL, Wood RA, Burks AW. J Allergy Clin Immunol. 2016 Aug 4. pii: S0091-6749(16)30531-0. doi: 10.1016/j.jaci.2016.05.027. [Epub ahead of print]. PMID: 27522159.

Nutrition Tip of the Day

Having trouble getting kids to eat vegetables? Try changing the shape. Grate carrots, make cucumber ribbons with a peeler, and cut peppers into stars using scissors. Give them creative names too — kids eat more power peas and X-ray vision carrots than plain ol’ peas and carrots.

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TV Ads and Posters Really Do Make Kids Eat Their Veggies

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Kids eat more vegetables when exposed to ad campaigns portraying them in a positive light, according to a study published online in Pediatrics. Researchers developed salad bar banners and television ads that portrayed vegetables as cartoon characters and placed them in elementary schools. Over 90 percent more students exposed to the banners chose options from the salad bar while over 200 percent more students exposed to both media techniques visited the salad bar, compared with students in schools that did nothing. These findings support previous research suggesting ads influence children’s school lunch choices, and researchers encourage food service operators to develop effective marketing campaigns to promote healthful eating habits.

Hanks AS, Just DR, Brumberg A. Marketing vegetables in elementary school cafeterias to increase uptake. Pediatrics. Published online July 5, 2016.

Tip of the Day

Eat Fatty Fish! Pretty much everyone agrees that fish is healthy. This is particularly true of fatty fish, such as salmon, which is loaded with omega-3 fatty acids and various other nutrients. Studies show that people who eat the most fish have a lower risk of all sorts of diseases, including heart disease, dementia and depression.

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End Mealtime Battles with One Question

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If you have picky eaters in your family, you already know the signs of when they dislike a meal: a blank stare, a turned-up nose, the plate pushed away. Instead of getting upset with their pickiness and falling into familiar mealtime battles, try a new tactic. Ask: “How can I make that better for you?” This question seems simple, but it can work like magic to open lines of communication between you and your children, and can give kids a feeling of control to make the meal more enjoyable. It also may take the pressure off you, since you won’t have to guess what they want — which changes frequently, anyway.

Phrasing is key. Instead of a negative question — such as, “Why don’t you like it?” — a positive question allows for constructive problem-solving and innovative solutions that you create as a team.

Make It Better

The first time you ask “How can I make that better for you?” your child may not know how to answer. That’s OK. Here are some common complaints and suggested solutions (note that nuts and seeds are choking hazards for children under 4):

  • “The food is too hot.”
    Put the plate in the fridge for a few minutes or add ice to hot soup.
  • “The food is too cold.”
    A quick zap in the microwave or a few minutes under the broiler will help.
  • “The food is plain.”
    Use “sprinkles” to add pizzazz to plates: flax seeds, sesame seeds, slivered almonds, fresh mint, shredded coconut, nutritional yeast, cinnamon, or shredded Parmesan or cheddar cheese.
  • “The food is boring.”
    Add a dip such hummus, guacamole, mild salsa or a yogurt-based tzatziki. A dollop of dip adds flavor and fun.
  • “The food is too crunchy.”
    Lightly steam vegetables or add a sauce or spread to crackers or toast.
  • “The food is too creamy.”
    Add texture to soup or yogurt with nuts, seeds, panko breadcrumbs, croutons, granola, diced vegetables or fruit
  • “The plate has [fill in the blank] on it, and I don’t like it.”
    Something as simple as a speck of green herbs or a bit of diced red pepper can be enough to ruin an entire dish for a child. Give your child permission to put the offending food to the side of the plate.

Be warned: The solution that works today may not work tomorrow. The answer to “How can I make that better for you?” will often change but it will always lead to some answer. Whether it’s a sprinkle of cheese or removing the “green stuff,” a simple question can save you from troublesome mealtimes and ensure everyone enjoys what they are eating.

Adapted from: Cara Rosenbloom, RD

Tip of the Day

Jot it down! Before making a grocery list, write down meals you want to make for the week. Shopping for the week means you’ll make fewer trips to the store and buy only the items you need.

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Do’s and Don’ts for Baby’s First Foods

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Introducing your baby to solid foods is an exciting milestone your little one is sure to enjoy. When you start introducing children to the world of solid foods, you are helping them shape food and feeding habits while establishing healthy eating patterns. Not sure how to get your baby started on solid foods? These tips will help.

Is My Baby Ready for Solid Foods?

DO check with your pediatrician before starting solid foods. Most people in the medical community agree the best time to start your baby on solid foods is at 4 to 6 months old. Look for physical signs that your baby is ready for solids, such as sitting up with limited support, good head and neck control and keeping most of the food in the mouth and swallowing it.

DON’T get caught up in comparing your baby’s progress or readiness to start solids to another baby. Not all babies reach milestones at the same time. Never force your baby to eat if crying or turning away when you offer solids. Your baby might not be ready to try eating from a spoon, or she might just not be hungry! Go back to nursing or bottle-feeding exclusively for a day or two before trying again.

What Should I Feed My Baby?

DO start with a single-grain infant cereal mixed with breast milk or formula, or a pureed fruit or vegetable. Some easily tolerated first foods are iron-fortified infant rice or oatmeal cereal, pureed avocado, banana, sweet potato, carrots, pears or peas. Mix breast milk or formula with your desired pureed food until it has a thin, liquid consistency. Gradually increase the thickness of the puree when your baby can swallow without trouble. Wait three to four days before introducing another food to your baby. If you suspect a reaction, stop feeding your baby the new food immediately and contact your pediatrician.

DON’T stop breast-feeding or formula-feeding just because you’re working on the switch to solids. Breast milk or formula is still your baby’s main source of nutrition and calories. And, even if it might seem like an easy out, never add honey, salt or sugar to baby food to “entice” or “trick” your baby into liking it.

How Do I Feed My Baby?

DO try to relax. Most of the first few solid-food feedings will wind up on your baby’s face, hands and bib. While there is no exact serving size of solid foods for babies, the general rule of thumb is to start small, giving your baby about one to two teaspoons of pureed food. Gradually increase this amount over time.

DON’T feed your baby solid foods from a bottle. Always spoon-feed from a bowl, not from the jar of food unless your baby will finish it. Feeding directly from the jar may introduce bacteria from your baby’s mouth to the spoon and back into the food, creating a food safety issue. If your baby is still hungry, use a clean spoon to take more food from the jar. Sometimes children will turn away from the spoon or clamp their mouth closed. If this happens, stop feeding your baby. It’s important to never force-feed a baby.

Whatever happens, don’t get discouraged and do enjoy the ride. With a little patience and creativity, you can make your baby’s first solid food eating experience fun for everyone involved!

Adapted from: Taylor Wolfram, MS, RDN, LDN

Tip of the Day

Shop smart! Beans and peas like kidney beans, split peas, and lentils, are low-cost protein options that are great for sides or main dishes.

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8 Ways to Get Picky Eaters to Become More Adventurous

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Getting kids to eat new foods sounds simple enough (“Just take one bite”). However, parents and caretakers know that for many children, new foods — with their new appearances, smells, tastes, textures, temperatures and names — can be scary. So, how can you get kids to develop positive relationships with food instead of mealtime battles? Try these eight fun tips to lay a foundation for stress-free, adventurous eating habits before the first bite.

Story Time

Learn about foods and recipes from around the world, including what children in different cultures eat. Read about food-based professions such as bakers, farmers and chefs. Watch cooking shows and videos with your kids about cooking and food prep.

Scrumptious Smells

Smell is a significant and sometimes forgotten part of the eating experience. Playing games to positively engage with food smells outside of mealtimes can demystify the experience. Use spice jars to guess scents or add vanilla extract to bubbles before blowing them outside. These non-eating activities will build happy associations with new smells before you use them in recipes.

Unleash the Artist

Make art projects using food. Use fruit to make stamps: halved strawberries make heart-shaped stamps, and halved apples are star-shaped. Use a string to make garlands or jewelry from uncooked pasta, popcorn or cranberries. (Popcorn and chunks of food can be choking hazards in young children.)

Flip the Script

Do you find yourself telling friends and family, “My child is a picky eater”? Train yourself to use hopeful language instead: “My child is learning to love new things.” Instead of “He doesn’t like it,” say, “He hasn’t had it enough times.” Using positive statements will validate your child’s feelings in your mind while recognizing that opinions can change.

Sort by Color

Chop brightly colored fruits and vegetables such as red cherry tomatoes, green kiwis and purple grapes into small pieces. Practice sorting them by color while saying the color aloud. This can cultivate an acceptance of new textures by allowing your child to focus on the game rather than on his or her discomfort with new foods. As with popcorn and apples, be aware that whole cherry tomatoes and grapes are considered choking hazards in young children.

Name It

Which do you think your child would rather eat: steamed carrots or X-Ray Vision Coins? In the same way that descriptions on restaurant menus can influence what you order, creative names in the kitchen or cafeteria can pique a child’s interest.

Shine the Spotlight

Many kids love being the star, so use that instinct to explore new foods. Take videos of your child speaking to his or her ideal audience — a younger sibling, a stuffed animal, a favorite superhero — about trying new foods.

Get in the Garden

A garden not only improves children’s knowledge of produce, it increases their consumption of fruits and vegetables. From flipping through seed catalogs in the winter, to starting seeds in the spring, to weeding and harvesting all summer long, gardens can be joyful and patient teachers.

Adapted from: Holly Larson, MS, RD

Tip of the Day

Be an active parent! Whether you’re watching a soccer game or at the park, get moving with your kids. Play with them on the jungle gym or walk up and down the sidelines of the game.

Daily Inspiration 

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